Doula for the dying: Austin woman shepherds people nearing death

Thursday

When she was 13 and living in Laredo in the 1970s, death invited Deanna Cochran to see behind its veil and pierce the hush surrounding what little she knew about dying.

Led by her grandmother to the bedside of a dying neighbor, she prayed with other women in the neighborhood and saw death treated, for the first time, like a natural part of life. She was awed by the experience, she said.

Years later as a nursing school graduate in 2000, she recalled the experience and knew after training with a hospice nurse that she wanted to work with dying patients.

"I call myself a doula to the dying," Cochran, 49, said from her Austin home last month. Doulas — the name was derived from the Greek word for slave — are increasingly hired to provide nonmedical support to women during labor and after childbirth.

Death doulas, or death midwives, harken to an old custom of sitting with the dying, but the tradition has faded and death doulas are not in big demand today. Cochran said that she knows of two others in Austin, including Donna Belk, a death midwife for about five years.

"It's tremendously needed," Belk said, "to help people with a peaceful death — to reframe death so it's not a horrible thing but the pinnacle of your life."

Belk, 61, conducts home funerals and says she focuses her midwifery work on coaching people through the dying process, assisting with their psychological, emotional and spiritual needs.

"The idea is to help people come to the process of dying with forgiveness work, writing your life story and putting a plan in place and using your imagination and personal beliefs so that you have an exit plan," Belk said. "You learn about leaving the body and giving yourself a place to go to, whether it is into the loving arms of Jesus or dissolving into the light of Buddha."

Cochran said she sees her role as providing whatever service the patient or family needs. Her emphasis is as much on the family or other caregivers as it is on the dying person.

Most often, Cochran said, the patient has chosen to die at home under hospice care, and Cochran says she sees herself as part of the hospice team. The family typically calls Cochran during the final days or weeks. Some want emotional and spiritual support. Some patients need a more peaceful setting in which to spend their last days, and Cochran gets busy clearing out clutter, lighting candles and finding fragrances that soothe the patient.

Some families need more mundane aid: help with insurance claims, cooking or talking through fears. And sometimes, Cochran draws on her hospice nursing skills to reinforce what the nurses already are doing. Cochran might administer medications or provide other nursing care, if asked.

Her goal is "to make sure the patient is comfortable and to make sure the family has as little anxiety as possible," she said. "I'm not about taking away the sadness. It is sad."

Diana Nadas Roloff, who moved to Austin with her husband, Mark Roloff, after Hurricane Katrina, found Cochran in 2007 through her website after Mark was diagnosed with ocular (eye) melanoma that had spread to his liver. Both were 56 when Mark got the diagnosis, and in a state of shock. Nadas Roloff called Cochran on Christmas afternoon, not expecting her to pick up the phone. But she did, and she came over that day. She told the couple she would stay with them as long as they wanted and spend the night if they needed her.

"I needed help and support. She knew the system. She was a hospice nurse," said Nadas Roloff, who has since moved back to New Orleans. "What Deanna did was, she gave me a shoulder to cry on."

Stan Wilson said he took comfort in knowing that Cochran was a nurse when his partner, Pat Tiemann, was dying of stomach cancer in 2007 and Cochran showed up to help them as a volunteer with Cancer Connection.

Both Wilson and Tiemann were 61, and Cochran helped Wilson with insurance forms and got Tiemann into a hospice program.

"The willingness to do just anything, to make things easier for me, that's what impressed me the most," Wilson said. "It was just heaven-sent."

Cochran and Belk said many people have no idea someone like them is available to assist dying patients and their families. To support herself and a daughter still at home, Cochran still works as needed as a hospice nurse, a career she started in 2001.

Death midwifery "doesn't seem like it's growing" in popularity, said Jon Radulovic, a spokesman for the National Hospice and Palliative Care Organization. "It's out there, and I know there are communities taking advantage of it u2026 but we are not necessarily hearing much about it."

Cindy Manning, case manager at Seton Cancer Screening and a board member at Cancer Connection, a network of cancer survivors and caregivers, met Cochran when she was fresh out of nursing school at Austin Community College and working in the cancer ward at Seton Medical Center.

"She had a gift," Manning said. Cochran had compassion for terminally ill patients and the ability to communicate with them and their families, Manning said. Cochran realized early that her style did not mesh with the fast pace of hospital nursing, and "I admire that she was able to pull away," Manning said.

Nine months after taking the job at Seton, Cochran went to work at a local hospice, and later she took care of her own mother when she was dying of bile duct cancer in 2005 at age 61. She took a break after that and started a landscape design business. But she said the pull of working with the dying was strong, and she decided within a few months to become an end-of-life doula. She set up a website and began blogging on end-of-life issues on the American-Statesman's website.

She said she deals with the heaviness by trying not to get too enmeshed in their lives. Otherwise, she could not be effective, she said.

"One of the things that helps me a lot is I watch a lot of funny movies," she said.

That's not to say it doesn't get to her.

"I've pulled over to the side of the road when I've left families, and I've just cried," she said. "I am OK with people dying. ... It's the families grieving that really affects me u2026 and the love that you see in the way they care for the person, especially the people who die who have 50 to 60 years of marriage behind them. It's incredible that you get gifted with that kind of relationship."

Death midwives are not for everyone, said Drew Rosielle, a blogger and a palliative medicine doctor at the University of Minnesota Medical Center-Fairview.

"I've seen many families who would want a knowledgeable presence there, especially in those last few days," he said. "It's a big unmet need. On the other hand, there are families who what they really want is privacy and help from the hospice nurse when they visit once a day — or help on the phone — but are really OK on their own."

Families seeking death midwives should look for someone who is well-trained in the care of the dying, he said. There is no standard certification program for them.

And while Rosielle said he hears little about families seeking out someone like Cochran or Belk, he thinks that will change.

Rosielle said many people probably can't afford a doula because insurance doesn't cover their fees.

Cochran said she charges roughly $75 an hour, on average, but "I don't turn anybody away."

She considers it an honor to work with a dying person and his or her loved ones.

"They are trusting you at a time that is extremely vulnerable and scary," she said. "To be able to make a difference at that time, I couldn't think of anything better."

maroser@statesman.com; 445-3619

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